Health Insurance Marketplaces

The Affordable Care Act created Health Insurance Exchanges/Marketplaces, where individuals, families, and small businesses that do not provide health care coverage to their employees can learn about affordable health coverage, compare insurance plans, and enroll in coverage. As part of Marketplace coverage, many enrollees receive financial help through tax credits, increased preventive care, the right to appeal when denied coverage, and choice of doctors. Furthermore, eliminating barriers to care such as denial of benefits for pre-existing conditions ensures affordable, quality health care coverage for everyone.

Marketplaces can be created by individual states but the federal government will step in to operate the marketplace for any state that opts out. For more information on the Marketplace in your state, visit healthcare.gov.

Health plans offered through the Marketplaces are known as Qualified Health Plans (QHP). The requirements for QHPs depend on the type of exchange (State-based, State Partnership and Federally Facilitated) within the state, creating some slight differences in rules that apply to participating plans. This can impact the provision of care by health centers insofar as network adequacy, contracting, and payment are concerned.

Important Links

healthcare.gov– The federal government’s health care coverage website. Individuals, families, and small businesses can sign up for insurance.

Kaiser Health News Timeline of changes to the Affordable Care Act

National Conference of State Legislator’s State Actions to Implement Health Insurance Exchanges

Kaiser Family Foundation’s State Health Exchange Profiles (Kaiser Health Reform Source)

CMS/CCIIO General Guidance on Federally-facilitated Exchanges

Helpful Resources

NACHC Fact Sheet: Qualified Health Plans & Health Centers, A Primer

NACHC Fact Sheet: Health Insurance Exchanges, Key Issues for Community Health Centers

NACHC State Policy Report: Navigating the Health Insurance Marketplace, Community Health Centers and Consumer Assistance Programs

NACHC State Policy Report: Promising Practices for Reaching and Enrolling Children

NACHC State Policy Report: Medicaid Premium Assistance and Health Insurance Exchanges

NACHC State Policy Report: Health Insurance Exchanges: Powers and Issues

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